Name Email

Phone Birthdate Male Female

Street Apt #

City State ZIP

Coach Preference(s) see Coach Bios

Height Weight

Do you have medical insurance? Yes No

Event Personal Best Year

Event Personal Best Year

Event Personal Best Year

Event Personal Best Year

Occupation

What are your reasons for seeking personal coaching?

Do you currently have a team or personal coach?

How did you find out about Fast RunnerZ?

Running History

How many years have you been running?

Events and times of competitions in the last 12 months:

Describe in detail your normal warm-up routine before a race or practice.

Describe in detail your last 4 weeks of training. (week 1, week 2, week3, week4)

Briefly describe your last 12 months of training.

How many miles per week do you run?

What is the distance of your longest run (miles)?

What is your average pace per mile for a moderate effort run and an easy effort run?

What training has worked well for you in the past and what training has NOT worked well?

Health History

Describe any injuries and when they last occured.

Do you have any health problems or family history of health problems which might affect or limit your training?

Are you currently using medication that may affect your training? Are you taking any supplements?

Goals

What are your short term goals (6 months or upcoming season)

What are your long term goals?

List any specific races and their dates that you want to compete in over the next 12 months and indicate which ones are most important.

Please rate yourself in the following categories.
Personal Rating: (1 = poor, 10 = outstanding)
Endurance
Speed
Power
Strength
Pain tolerance
Commitment
Flexibility
Core Strength
Motivation
Recovery
Attitude

What are your strengths?

What are your weaknesses?

Training Equipment

Do you have access to the following?

Outdoor track: Yes No

Indoor track: Yes No

Trails or dirt roads: Yes No

Large grass area: Yes No

Health club: Yes No

Swimming pool: Yes No

Weight room: Yes No

Stationary bike: Yes No

Treadmill: Yes No

Hilly running area: Yes No

Dumbbells: Yes No

Miscellaneous

Are there any other problems you have pertaining to competing or training?

Do you cross train? (bike, pool, etc) How often?

Do you train with a group or partner? On what days? For what kind of training?

Any other comments or information you want us to know?

 

WAIVER OF LIABILITY; RELEASE; ASSUMPTION OF RISK; INDEMNITY
Carfully read the following and type your name ONLY if you agree to the terms.

In consideration of services provided by "Fast RunnerZ", I, for myself, my heirs, representatives, administrators, executors and assigns, knowingly and voluntarily, hereby: 1. TO THE FULLEST EXTENT ALLOWABLE UNDER LAW, WAIVE, RELEASE, FOREVER DISCHARGE, COVENANT NOT TO SUE, HOLD HARMLESS, AND AGREE TO INDEMNIFY FAST RUNNERZ, ITS OFFICERS, DIRECTORY, AGENTS, EMPLOYEES, AND/OR REPRESENTATIVES, AND/OR ALL OWNERS OF THE Facilities and/or the agents and employees of such owners (collectively, the "Related Parties"), FROM ANY AND ALL CLAIMS, losses, damages (including direct, indirect, actual and consequential damages ), demands, suits and/or other actions, including claims arising out of negligence (collectively, "Damages"), ARISING OUT OF OR IN ANY WAY RELATED TO MY USE OF ANY OTHER ACTIVITY CONDUCTED AND/OR MY PARTICIPATION IN ANY RUNNING RELATED ACTIVITIES /OR SUPERVISED BY ANY OF THE RELEASED PARTIES (the "Activities"). 2. Represent that I do not suffer from any physical ailments, limitations, disabilities or other conditions that might hinder my ability to participate in the above-listed activities without risk to my health. I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS TERMS. BY SIGNING THIS DOCUMENT, I VOLUNTARILY ACCEPT ITS TERMS AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWABLE BY LAW. I AGREE TO INDEMNIFY FAST RUNNERZ AS PROVIDED HEREIN. FURTHER, I AGREE IF ANY PORTION OF THIS DOCUMENT IS HELD TO BE INVALID OR UNENFORCEABLE, THE REMAINDER SHALL NOT BE AFFECTED. IMPORTANT: Participants understand the inherent risk of rigorous running and should consult a physician prior to beginning. Participants assume all risk. A legal guardian must sign this waiver for children under the age of 18 years and bears full responsibility for the child's safety and welfare.

By typing your name, you are agreeing to and signing the above waiver.

Full Name *Required